Apparatus and method for preparing bone for anti-rotational implantation of an orthopedic endoprosthesis

ABSTRACT

An apparatus and method for reaming a bone, facilitating pre-implantation alignment of a prosthesis using trial components, and preparing a bone site for anti-rotational implantation of the prosthesis is provided. The apparatus includes a boring end, a mating end disposed opposite the boring end, and a keying aid disposed between the boring end and mating end. The keying aid facilitates preparation of the bone canal for anti-rotational placement of a prosthesis having an anti-rotational component, or key. The method includes attaching a power tool to the mating end of the apparatus, reaming a bone canal with the boring end of the apparatus, detaching the power tool, attaching a trial component, conducting alignment trials, maintaining the apparatus in the desired position, detaching the trial component, cutting at least one keyway in the bone canal using a cutting device and the keying aid of the apparatus, removing the cutting device, removing the apparatus from the reamed bone canal, and inserting the prosthesis into anti-rotational engagement with the reamed bone by aligning the key on the prosthesis with the keyway in the bone canal.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. application Ser. No.10/248,565, filed on Jan. 29, 2003, the disclosure of which isincorporated herein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to a surgical tool and method for preparing abone site for implantation of an orthopedic endoprosthesis havinganti-rotational components as well as facilitating pre-implantationalignment of the prosthesis. More particularly, the invention relates toaligning and implanting a femoral component of a total hip joint or ahumeral component of a shoulder joint. However, it may also be used toalign and implant femoral and tibial components of a prosthetic kneejoint.

The method and surgical tool that is used to open and form the bonecanal also facilitates pre-implantation alignment of the prosthesisusing trial components, as well as preparation of the bone site foranti-rotational implantation of the prosthesis. Most commonly, thisinvention would be employed in connection with the implantation ofprostheses into long bones, but it would not be limited thereto. Thequantity of medical instruments, as well as the time and number ofmovements required in forming a bone canal and conductingpre-implantation alignment of the prosthesis using trial components isreduced with the use of this surgical tool. Also, the risk of rotationalfailure of the prosthesis is reduced when it is implanted into a bonecanal that is shaped to accept it's anti-rotational features.

As used herein, when referring to bones or other body parts, the term“proximal” means closest to the heart, and the term “distal” means moredistant from the heart. When referring to tools and instruments, theterm “proximal” means closest to the practitioner, and the term “distal”means distant from the practitioner.

2. Description of Related Art

Proper alignment of orthopedic implants, such as joint replacementprostheses, is essential to the success of surgical procedures involvingreplacing damaged joints. Such prostheses commonly include stems forinsertion into the canals of long bones. A stem is used to anchor theprosthesis in a bone cavity.

A bone cavity is commonly prepared by forming a hole in the bone, suchas by drilling or reaming, and creating an opening sized and contouredto receive the stem of the prosthesis. The stem is inserted into thebone cavity, and optionally, a joint bearing member may be attached orcoupled to the stem, with the joint bearing member extending out of thebone cavity.

Typically, once a stem that is coupled to a femoral component, forexample, is inserted into a prepared bone cavity, it is necessary torotate the stem to properly orient it. Sometimes, the stem must beremoved and reinserted, which may damage the bone cavity and surroundingbone, as well as increase intra-operative time.

To achieve pre-implantation alignment of the prosthesis, the prosthesisstem is typically manipulated, and the desired position identified, bymarking the bone and the stem. Subsequent alignment during implantationis then achieved by using the marks to align the stem with respect tothe bone. The drawback to this method is the potential imprecision inthe alignment. Because the marks on the stem and bone are not in closeproximity to each other, parallax and other problems associated withalignment by eye may result. Also, the stem may move from its alignedposition as it is inserted.

Misalignment of an implanted prosthesis in the human body is anundesirable result in joint replacement surgery. To alleviate implantmisalignment, past efforts have been directed toward providing somepre-implantation trialing and marking methods that strive to achieve animplanted prosthesis having the optimal orientation.

One such effort is presented in U.S. Pat. No. 4,678,471 to Noble et al.,entitled “Method and Apparatus for Preventing Rotational Failure ofOrthopedic Endoprostheses”. Noble et al. relates to an apparatus formaking at least one groove in a medullary canal in a bone. The apparatusis an elongate member having a flattened head portion and a stem, andhaving one channel that receives a cutting tool for cutting a groove inthe canal, remote from the resected bone surface.

Another effort is presented in U.S. Pat. No. 5,053,037 to Lackey,entitled “Femoral Instrumentation for Long Stem Surgery”. Lackey relatesto a bone cutting block in conjunction with a reamer, for forming theend of a long bone.

Yet another effort is presented in U.S. Pat. No. 6,206,884 to Masini,entitled “Reduction-Based Joint Replacement Apparatus and Methods”.Masini relates to a reduction-based orthopedic system facilitating theinstallation of a properly oriented prosthetic component. Separateelements of the system for trialing and marking the bone include ananchoring unit, a trialing component, and a cutting guide.

Despite these efforts, there is still a continuing need for improvingtools and methods for preparing a bone site for implantation of aprosthesis having anti-rotational components as well as facilitatingpre-implantation alignment of the prosthesis.

It is therefore an object of the present invention to provide a surgicaltool which facilitates reaming a bone canal, attaching and manipulatinga trial component, and marking the rotational alignment of the trialcomponent on the bone.

It is a further object of the present invention to provide a surgicaltool which facilitates engagement to various tools and components forthe purposes of both reaming a bone canal as well as facilitatingtrialing.

It is yet another object of the present invention to provide a surgicaltool for cutting keyways in the bone once the rotational alignment ofthe trial component is determined.

SUMMARY OF THE INVENTION

These and other objects are achieved by the present invention, which isa surgical tool for reaming a bone, determining the rotational alignmentof a prosthesis, and marking this alignment on the bone.

The surgical tool has a first end adapted to extend into a bone canal ina bone, a second end opposite the first end preferably adapted to engagevarious instruments and other tools, and at least one keying aid that isadapted to facilitate identifying the tool's orientation on a bone. Thesurgical tool also has a central longitudinal axis.

The first end of the tool is cylindrical and has a cross-section that isperpendicular to the longitudinal axis. In the preferred embodiment, thefirst end has flutes and cutting surfaces, or teeth, to shape a bonecanal. The cutting teeth are intended to cut away undesired bone, whilethe flutes convey the cut bone out of the bone canal. It is understood,however, that other bone-removing features may be incorporated on thefirst end of the reamer to help prepare the bone canal for insertion ofan implant. It is further noted that a set of surgical tools may beprovided, each surgical tool having a differently sized cross-section.For example, a set of surgical tools having cross-sectional diametersranging from 11 to 19 millimeters may be provided.

In the preferred embodiment, the second end of the surgical tool has amating geometry that enables it to be engaged by various matinginstruments and trial implants. For example, the second end may beengaged by a power tool, or a manual tool such as a T-handle, that wouldrotate the surgical tool, causing the first end to ream and removeundesired bone from the bone canal. The second end may also be engagedby a trial component used for determining the rotational alignment of aprosthesis in the bone.

In the preferred embodiment, once placed on the second end of thesurgical tool, the trial component, such as a femoral component of aknee implant, may be rotated with the surgical tool in the bone canal,thereby allowing a surgeon to determine the desired orientation in whichhe wishes to permanently set the prosthesis. When these motions areperformed in conjunction with articulation of the joint being operatedupon, as is commonly known to those skilled in the art, this is referredto as “trial reduction”.

Once the desired orientation is determined, the surgical tooladvantageously has a combination of features or guides on the secondend, that facilitate marking the bone to identify this orientationthereon so that a prosthesis may be inserted in accordance with thisorientation. The combination of features includes a flange with twoalignment grooves on its outer periphery, and at least one, butpreferably four guide channels that penetrate the flange.

With regard to the flange, preferably one or both of the two grooves maybe used as guides for a surgical marker to mark the bone afterrotational alignment of the trial component has been performed. Once thebone is marked, the surgical tool may be removed from the bone canal.Thereafter, additional procedures known to those skilled in the art maybe employed to further prepare the bone canal for anti-rotationalimplantation of a prosthesis in accordance with the marks on the bone.For example, a surgeon may manually cut out a keyway in the boneadjacent to the bone canal and, using a prosthesis having a feature, orkey, corresponding to the keyway, insert the prosthesis so that itengages both the bone canal and keyway. This results in implanting theprosthesis in accordance with the mark relating to the desired positionpreviously set by the trial component.

Alternatively, once the desired orientation for the prosthesis isdetermined, the trial component may be disengaged from the surgical toolwhile maintaining the tool's position in the bone canal. The four guidechannels may then be used to shape the bone canal by forming keyways,thereby preparing the bone canal for implantation of a prosthesis havinganti-rotational components, or keys.

Preferably, the four guide channels each have a longitudinal guidechannel axis, as well as a cross-section, or profile, that isperpendicular to the guide channel axis. The four guide channels areadvantageously located on the surgical tool such that their profilesoverlap, or intersect the cross section of the first end of the surgicaltool. In the preferred embodiment, the four guide channels are spacedequidistantly, equiangularly and parallel to the longitudinal axis ofthe surgical tool, but other variations are possible. For example, theguide channels may be oriented such that their guide channel axes arenot parallel to the longitudinal axis of the surgical tool.

The guide channels are each adapted to accept a drill bit and direct thedrill bit to cut anti-rotation channels, or keyways, on the periphery ofthe bone canal, thereby forming a non-circular bone canal cross-section.It is also recognized, however, that other tools, such as a rasp orpunch, may be used in conjunction with the guide channels to form thekeyways.

In the preferred embodiment, the grooves on the flange and the guidechannels are preferably used in combination. The grooves are used tomark the surgical tool's orientation on the bone, and then the guidechannels are used to form the keyways in the bone canal. Thereafter, themarkings made by using the grooves help validate the correct positionsof the keyways.

In the preferred embodiment, the distal portion of the flange that facesthe first end of the surgical tool, transitions smoothly into the secondend of the surgical tool via a chamfer or fillet, such that, whenapplied, it registers a countersink on the top surface of the bonecanal. However, it is envisioned that a substantially perpendiculartransition may be made as well. Therefore, according to the preferredembodiment, keyways are formed on the countersink or radius in the bonecanal. Alternatively, with a flange having a substantially perpendiculartransition, the keyways would be formed on the top surface of the bonecanal without the countersink or radius.

Once the anti-rotation channels are formed, the surgical tool is removedfrom the bone canal. The prepared bone canal then receives a prosthesishaving a stem with anti-rotational components, such as keys, that alignwith the cut keyways, and help secure the prosthesis from rotating inthe bone canal.

The preferred method of using the present invention includes attaching apower tool to the second end of the surgical instrument, advancing thesurgical instrument into the bone canal, disengaging the power tool fromthe surgical instrument, attaching a trial component to the second endof the surgical instrument, determining the desired orientation of aprosthesis by moving the trial component relative to the bone canal,marking the desired orientation on the bone with the aid of the surgicalinstrument, disengaging the trial component from the surgical instrumentwhile holding the surgical instrument stationary in the bone canal,drilling keyways adjacent to the bone canal with drill bits guided byguide channels in the second end of the surgical tool, removing thesurgical tool from the shaped bone canal and implanting a prosthesishaving anti-rotational elements, such as keys thereon, for engaging thekeyways in accordance with the desired orientation previously determinedwith the trial component.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings, wherein similar reference characters denote similarelements throughout the several view:

FIG. 1 is a perspective view of the surgical tool.

FIG. 2 is a top view of the surgical tool depicted in FIG. 1.

FIG. 2A is a cross-section of the surgical tool along line 2A in FIG. 1.

FIG. 3 is an exploded view of a driving tool, the surgical tool and aresected end of a proximal femur.

FIG. 4 is a partially exploded view of a trial component positioned overthe surgical tool which is situated in the bone canal of the proximalfemur.

FIG. 5 is a partially exploded view of a marker positioned over thesurgical tool which is situated in the bone canal of the proximal femur.

FIG. 6 is a partially exploded view of a drill bit positioned over thesurgical tool which is situated in the bone canal of the proximal femur.

FIG. 7 is an exploded view of a prosthesis positioned over a bone canalin the proximal femur that was formed with the surgical tool.

DETAILED DESCRIPTION

Referring to FIGS. 1 and 2, there is illustrated the surgical tool orinstrument of the present invention, generally denoted as 10. In thepreferred embodiment, instrument 10 has a first distal end 100 and asecond proximal end 200 extending along longitudinal axis 110. First end100 is in the form of a reamer 102 used to ream a bone canal in a longbone, while second end 200 has multiple applications including providingan attachment interface to various instruments, and providing elementsfacilitating marking and forming keyways in the bone. Both ends 100 and200 of instrument 10 will be discussed in more detail, below.

With reference to FIGS. 1-3, in the preferred embodiment, reamer 102 hasmultiple spiraled cutting teeth 120 for reaming bone canal 710 to adesired diameter. Cutting teeth 120 form a circular cutting profile 130that is perpendicular to longitudinal tool axis 110. Profile 130 isessentially the cutting perimeter of first end 100 of instrument 10. Itis also envisioned that other forming elements may be incorporated atfirst end 100 of surgical instrument 10 to facilitate other commonmethods of preparing bone canal 710, such as features for cutting,rasping, impacting or otherwise forming bone canal 710.

Referring to FIGS. 1 and 2, reamer 102 is a standard bone reamer whereineach spiral cutting tooth 120 has a cutting edge 122 that engages theinner circumferential surface 712 of bone canal 710. When reamer 102 isrotated clockwise R, undesired bone in bone canal 710 is cut away bycutting edges 122 and conveyed out of bone canal 710, toward second end200, via flutes, or channels 124 on reamer 102. In this manner, loosebone particles do not remain in bone canal 710 during drilling.

In the preferred embodiment, as best seen in FIG. 1, between reamer 102and flange 280, is a circumferential series of cutting teeth 220 andguide channels 230. Straight cutting teeth 220 run substantially fromthe end of spiraled teeth 120 up to the bottom of flange 280. Thesestraight cutting teeth 220 further facilitate shaping bone canal 710.Four guide channels 230 are formed intermediate the straight cuttingteeth 220, although it is recognized that at least one guide channelwould suffice. Since guide channels 230 are straight, cutting teeth 220must also be straight, as opposed to spiraled, so that guide channels230 do not have interruptions in their lengths.

A recessed transition portion 150 is provided as a separation betweenspiraled teeth 120 and straight teeth 220. This is primarily formachining purposes. It is understood, however, that various othertransition configurations may exist for this purpose.

Proximal of cutting teeth 220, second end 200 includes flange 280 which,in the preferred embodiment, has a generally cylindrical shape centeredabout longitudinal axis 110. The distal portion of flange 280 that facesfirst end 100 of surgical tool 10, transitions smoothly into second end200 via a chamfer or fillet, such that, as shown in FIG. 7, it registersa countersink or radius 716 on top surface 740 of bone canal 710.

Flange 280 further has two oppositely oriented substantially flatsurfaces 282 extending parallel to axis 110 and two radially extendingmating surfaces 284 positioned perpendicularly to axially extendingsurfaces 282. As best seen in FIG. 1, second end 200 also has acylindrical surface 290 terminating in an annular mounting recess 272,and an annular mounting lip 270 just above recess 272. Lip 270, recess272, and surfaces 282 and 284 provide features and surfaces forengaging, or facilitating the mounting of, various instruments such asdriving tools and trial components, which will be discussed in moredetail, below. Numerous alternative configurations and features,however, are also envisioned. Additionally, a counter-rotation hole 250,and a retraction hole 260, both located on the second end 200 ofinstrument 10, are provided, and will be discussed in more detail,below. Moreover, it is recognized that while having any of the featuresof second end 200 described herein, second end 200 may also be shaped,at least in part, as a trial component.

Flange 280 further has oppositely oriented alignment marking grooves 240on its periphery. These grooves 240 may be used to mark the rotationalorientation, or position of instrument 10, on resected bone surface 740of bone 700.

In the preferred embodiment, second end 200 of instrument 10 also hasfour peripherally located guide channels 230 that run distally alongsurface 290 of second end 200, penetrate flange 280, and terminate attransition portion 150. With particular reference to FIG. 2A, preferablyeach guide channel 230 has a circular profile 232 which is perpendicularto a guide channel axis 210, and at least in the area of teeth 220distal of flange 280, is partially open. As seen in FIG. 2, each guidechannel 230 is oriented on instrument 10 such that guide channel axis210 is substantially parallel to longitudinal tool axis 110, and profile232 intersects cutting profile 130, i.e., the full circular profile 232of each channel 230 extends beyond the diameter of profile 130. However,other configurations of guide channel axes relative to the longitudinaltool axis are also envisioned. As will be explained in more detailbelow, the intersecting profiles on instrument 10 facilitate forming acylindrical bone canal having anti-rotation keyways.

Guide channels 230 are shown in FIGS. 1 and 2 as being equidistantly andequiangularly spaced apart from each other, however it is envisionedthat other geometric configurations are conceivable as well. Inaddition, as few as one channel can be used. As will be discussed belowin more detail, grooves 240, as well as guide channels 230, are used tothe mark the rotational position of instrument 10 on resected bonesurface 740, and guide channels 230 may be further used to form keywaysin bone canal 710 in order to prepare it to receive an implant havingcomplimentary anti-rotational elements, or keys, formed thereon.

Referring to FIG. 3, instrument 10 is shown positioned over an unreamedbone canal 710 in a bone section such as the resected proximal femur700. It is recognized, however, that the bone section may also be adistal femur, or an end of the tibia or humerus. Above instrument 10 isthe driver interface portion 310 of a driving tool, or driver 300 suchas a manual or power drill. In operation, driver interface 310 of driver300 engages instrument 10 at end 200 via mounting lip 270, mountingrecess 272, vertical mating surfaces 282 and horizontal mating surfaces284. Such an engagement of parts facilitates controlled manipulation ofinstrument 10. Specifically, if driver 300 is a drill, then clockwise Rrotation of driver 300 translates through second end 200 into rotationof reamer 102, thereby causing first end 100 of instrument 10 to shapebone canal 710.

With reference to FIG. 4, once bone canal 710 has been reamed, and theunderside of flange 280 of instrument 10 is in flush contact withresected bone surface 740, driver 300 is disengaged from proximal secondend 200. At this point, without removing instrument 10 from bone canal710, a trial component, such as the one depicted by hip joint element400, may be placed on second end 200. In the preferred embodiment, trialcomponent 400 has a similar interface configuration 410 as the interface310 of driver 300, and mates similarly with second end 200.

While engaged to second end 200, trial component 400 and instrument 10may be freely rotated to any position, and trial reduction may beperformed. This allows a surgeon to determine the optimal orientation oftrial component 400 for implantation into proximal femur 700 in view ofthe actual expected function of a prosthesis in the hip joint.

Referring to FIGS. 5-7, once the optimal orientation of trial component400 is set, this position may be marked on proximal femur 700 in atleast one of two ways. In one approach, without disengaging trialcomponent 400 from second end 200, a marking instrument 500, such as amarker 510, may be set against groove 240 on flange 280 of instrument10, and used to mark resected bone surface 740. Optionally, both grooves240 may be used to make such marks on bone surface 740. These marksidentify the desired rotational orientation in which implant 600 shouldbe implanted into proximal femur 700. Alternately, marking may be doneby using the drill bit 520 of FIG. 6, which may be guided along grooves240 to make indentations (not shown) in resected bone surface 740. Oncethe marks are made on bone surface 740, instrument 10 may be removedfrom bone canal 710, and further preparatory measures may be implementedin accordance with procedures known to those skilled in the art, forpreparing the marked implant site for anti-rotational implantation ofimplant 600.

Alternatively, once the optimal orientation of trial component 400 isset, while keeping instrument 10 in its determined rotational positionin bone canal 710, trial component 400 is disengaged from second end 200of instrument 10. Drill bit 520 is then attached to a drill (not shown),inserted into at least one guide channel 230, and used to drill at leastone keyway 730 on the periphery of bone canal 710. It is alsorecognized, however, that other tools, such as a rasp or punch, may beused in conjunction with the guide channels to form the keyways.Straight and uninterrupted guide channels 230 advantageously facilitateinsertion and controlled manipulation of drill bit 520 during thisprocess.

In the preferred embodiment, the grooves on the flange and the guidechannels are used in combination. The grooves are used to mark thesurgical tool's orientation on the bone, and then the guide channels areused to form the keyways in the bone canal. Thereafter, the markingsmade by using the grooves help validate the correct positions of thekeyways.

In order to prevent instrument 10 from rotating in bone canal 710 whileanti-rotational channels 730 are being drilled, there is provided acounter-rotation hole 250 on instrument 10. Counter-rotation hole 250penetrates instrument 10 through flange 280, substantiallyperpendicularly to longitudinal tool axis 110, and in between verticalmating surfaces 282. During the drilling of channels 730, a bar or tool(not shown) may be inserted into hole 250, and held in position toprevent instrument 10 from rotating.

Once anti-rotation channels 730 are prepared, drill bit 520 may beremoved from instrument 10. To assist in removing instrument 10 frombone canal 710, there is optionally provided a threaded retraction hole260 on second end 200 of instrument 10. A tool (not shown) may bethreadably inserted into hole 260, and then used to facilitate theretraction of instrument 10 from bone canal 710. The result of thereaming and drilling process described by the second approach herein, isa bone canal 710 having a countersink 718, smooth circumferential canalsurface 714, and at least one keyway 730. It is understood, however,that if the transition between flange 280 and second end 200 issubstantially perpendicular, the keyway 730 would be formed on topsurface 740 of bone canal 710 without countersink 716.

Now that the forming of bone canal 710 has been completed, an implantsuch as the one depicted in FIG. 7 by element 600, havinganti-rotational components, or keys 610, may be implanted into bonecanal 710 according to the previously measured, marked and machinedorientations of keyways 730. The mating of keys 610 with keyways 730, onthe periphery of bone canal 710, helps prevent the rotation of implant600 about its axis 110 within bone canal 710 after implantation.

Instrument 10, as taught herein, is used to prepare an intramedullarybone canal 710 in the proximal femur 700 for anti-rotationalimplantation of implant 600. However, it is noted that in a variety ofsizes, instrument 10 and the methods for its use, may be implemented onother joints for similar procedures. For example, the distal femur,tibia and the proximal humerus may be prepared in a similar manner toaccept a prosthesis for interaction with the knee or shoulder joint,respectively.

Although the invention herein has been described with reference toparticular embodiments, it is to be understood that these embodimentsare merely illustrative of the principles and applications of thepresent invention. It is therefore to be understood that numerousmodifications may be made to the illustrative embodiments, and thatother arrangements may be devised, without departing from the spirit andscope of the present invention as defined by the appended claims.

1. A method of preparing a bone for insertion of a prosthesis, saidmethod comprising: forming a bone canal in a bone utilizing a surgicalinstrument; engaging a trial component to said surgical instrument;moving said trial component while said trial component is engaged tosaid surgical instrument, and while said surgical instrument ismaintained in said bone canal, to determine an implanting position forsaid prosthesis; marking said implanting position on said bone by usingsaid surgical instrument as a guide; removing said surgical instrumentfrom said bone canal; and implanting said prosthesis in said markedimplanting position in said bone.
 2. The method of claim 1 furthercomprising attaching a power tool to said surgical instrument tofacilitate forming said bone canal in said bone.
 3. The method of claim1 wherein moving said trial component comprises performing trialreduction.
 4. The method of claim 1 further comprising marking saidimplanting position on said bone by utilizing said surgical instrumentas a guide.
 5. The method of claim 4 wherein marking said implantingposition on said bone comprises utilizing said surgical instrument as aguide in forming at least one anti-rotation channel in said boneadjacent to said bone canal, said at least one anti-rotation channelhaving a channel axis and a channel profile that is perpendicular tosaid channel axis.
 6. The method of claim 5 further comprising formingsaid at least one anti-rotation channel such that said channel profileintersects said bone canal.
 7. The method of claim 5 further comprisingforming said at least one anti-rotation channel such that said channelis substantially parallel to said bone canal.
 8. The method of claim 5further comprising forming said at least one anti-rotation channel suchthat said channel profile intersects said bone canal and saidanti-rotation channel is substantially parallel to said bone canal. 9.The method of claim 5 wherein said prosthesis has a key, and implantingsaid prosthesis in said marked implanting position in said bonecomprises aligning said key with said at least one anti-rotation channeland inserting said prosthesis in said channel such that said key engagessaid anti-rotation channel.
 10. The method of claim 4 wherein markingsaid implanting position on said bone comprises utilizing said surgicalinstrument in forming multiple anti-rotation channels in said boneadjacent to said bone canal, each of said multiple anti-rotationchannels having a channel axis and a channel profile that isperpendicular to said channel axis.
 11. The method of claim 10 furthercomprising forming said multiple anti-rotation channels such that eachof said channel profiles intersects said bone canal.
 12. The method ofclaim 10 further comprising forming said multiple anti-rotation channelssuch that each of said multiple channels is substantially parallel tosaid bone canal.
 13. The method of claim 10 further comprising formingsaid multiple anti-rotation channels such that each of said channelprofiles intersects said bone canal and each of said multiple channelsis substantially parallel to said bone canal.
 14. A method of preparinga bone for insertion of a prosthesis, said method comprising: forming abone canal in a bone; associating a surgical instrument into said bonecanal; performing trialing using said surgical instrument to determinean implanting position; marking said implanting position on said bone byusing said surgical instrument as a guide; disassociating said surgicalinstrument from said bone canal; and implanting said prosthesis in saidmarked implanting position in said bone.
 15. The method of claim 14wherein forming said bone canal is performed by reaming said bone. 16.The method of claim 14 wherein performing trialing comprises performingtrial reduction.
 17. The method of claim 14 wherein marking saidimplanting position on said bone includes utilizing said surgicalinstrument in forming multiple anti-rotation channels in said boneadjacent to said bone canal.